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The ProviderTrust Blog

Your source for healthcare compliance news, advice from industry experts, and all things related to OIG exclusions.

Industry News, Medicare, Fraud and Abuse

Chicago U.S. Attorney's Office Creates New Healthcare Fraud Unit

Posted by Michael Rosen, ESQ on Wed, Jul 26, 2017

The Chicago U.S. Attorney's Office is creating a new unit to prosecute healthcare fraud. Assistant U.S. Attorney Heather McShain will lead the team of five prosecutors. The team brings local focus on combatting fraud in Medicare, which has been a national priority for the U.S. Department of Justice (DOJ) for nearly a decade.

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Healthcare Compliance, OIG, corporate integrity agreements

Settlement Considerations: CIA or No CIA?

Posted by Harold Malkin on Fri, Jul 21, 2017

We are pleased to welcome a guest today on the blog - Harold Malkin, a former Assistant U.S. Attorney who specialized in the resolution of civil healthcare fraud cases involving individual providers, medical practices and institutional providers in the Western District of Washington in Seattle for over 15 years. In this article, Harold will highlight some important information regarding the permissive and mandatory exclusion authority of the Office of Inspector General (OIG) as well as some things to consider if you find yourself in settlement discussions with OIG.

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OIG, Fraud and Abuse, Compliance Plan, exclusion monitoring

OIG Continues Focus on Skilled Nursing Facilities

Posted by Donna Thiel on Tue, Jul 18, 2017

Like most compliance officers, I receive compliance updates in my inbox every day from various vendors, compliance organizations, and of course the Office of Inspector General and Department of Justice. I always make sure to read all of the recent government settlements but maybe because of my background and love for the post-acute sector, I continue to notice how frequently the OIG and DOJ focus on the post-acute sector, and often more specifically on skilled nursing facilities.

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OIG Exclusion List, OIG, Medicaid, mfcu

MFCU Reporting Accuracy: Then and Now

Posted by Michael Rosen, ESQ on Thu, Jul 13, 2017

The Office of Inspector General (OIG) is not the only source for exclusions. Did you know that the state Medicaid agency and/or State Attorney General, if applicable, in each state must report its actions to the Federal OIG promptly after the agency takes a final action? (Social Security Act 1902(a)(41) and 42 CFR 1002.3(b)(3). In this article, we'll take a look at how well reporting has taken place given the latest OIG research data, and compare Q1 2017 results from our latest CHIRP report.

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Industry News, OIG, Medicaid, Fraud and Abuse

C-Suite and General Counsel Held Liable for Medicaid Fraud

Posted by Michael Rosen, ESQ on Tue, Jul 11, 2017

Larger healthcare companies typically employ an entire and robust legal department in-house to handle legal work and provide good counsel to management and senior executives. Some of these companies will hire outside counsel to supplement areas of expertise that may be lacking by an internal department. But what happens when that advice or legal counsel is considered to be fraudulent? Who is liable? Who takes the fall and can be subject to the long arm of the law?

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